| NPI | 1003921164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 2457-C) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AR 1693-M) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-11-12 |